87. You know I hate to ask, but are friends electric?

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A patent magneto electric machine. USB C adaptor is $40 extra.

In August, I took an Australian visitor to Lincoln Castle for a good slice of History. Everywhere there were flamboyant characters in Victorian outfits and I soon realised Lincoln was hosting a steampunk festival and we were getting more History than just the Magna Carta.

Officially called The Asylum Festival, the event centred on The Lawn hospital, near Lincoln Castle, an early nineteenth century building which, until 1985, served as a mental hospital.

In this case, and in general, it’s easy to argue that steampunk is filling not just a building but also a cultural void at the Lawn vacated by psychiatry, at least in terms of celebrating the Gothic.

According to wikipedia, Steampunk refers to a subgenre of science fiction and sometimes fantasy that incorporates technology and aesthetic designs inspired by 19th-century steam-powered machinery.

Contrast with Psychiatry, which refers to a subgenre of medicine and sometimes fantasy that incorporates technology and aesthetic designs inspired by 19th century electrical-powered machinery.

Another attempted definition of Steampunk is ‘modern technology—iPads, computers, robotics, air travel—powered by steam and set in the 1800’s’.

Again, contrast with psychiatry, which is all about old ideas (mental energy, chemical deficiencies, mindfulness etc) set in a concrete building on a business park modelled on George Smiley’s HQ.

The point is, Steampunk celebrates the art of anachronism, whereas psychiatry regards it with a mixture of hatred and denial.

The Lawn was opened in 1819, which was before the reign of Queen Victoria, but most of the British Asylum hospitals were built during the Victorian period. Many of them were gothic in style, making them a suitable venue for wearing top hats and tinted goggles, riding round on penny farthings and racing steam robots.

Nowadays, psychiatry is shy about its Victorian heritage. The contribution of Freud and his colleagues is celebrated only in terms of a sprinkling of multiple choice questions. Freud’s early work would now be called Neuroscience and we know that he was intrigued by nerve tissue and would have taken a much more Electric road, if only he’d had access to multipacks of AAA batteries or a USB charger.

Freud knew that the brain was electrically powered – indeed this discovery went back to the end of the eighteenth century. He attributed symptoms like hysterical paralysis to mental energy short-circuiting down the wrong pathways.

Since the Victorian era of psychiatric treatment, electricity popped up as a treatment option at frequent intervals. Nowadays there are many people working on various kinds of electrical brain stimulation, such as deep brain stimulation, transcranial direct current brain stimulation (tDCS), magnetic stimulation and the original and genuine product, ECT.

This is not, you understand, the official penchant of British psychiatry, which by convention pretends to emphasise social and psychological approaches. You’re supposed to listen actively for at least five minutes before getting the talk round to tablets and quite a bit longer before mentioning the E word. That’s just a convention. I wouldn’t call it hypocritical, more, let’s say ‘dual mode’.

People say they want to be listened to more than anything else, but that stance also can be a little dual-modish. Quite a number of patients are in search of physical treatments of one kind or another and want to seek medical advice before buying batteries and sponges from B and Q.

Talking yes, counselling certainly, making a few changes to your life, I guess so, but hey, just tossing an idea out there, how about electricity?

Sadly, the custodians of ECT, psychiatrists and their colleagues in mental health trusts, have completely failed to market their product at all. The number of people prescribed ECT has declined dramatically over the years. Depending on where you stand on this argument, either it is being enormously under-utilised or you can’t believe it’s still going on at all.

Because the NHS mainly seeks to discourage people turning up to use its services, nothing much has been done to promote electrical treatments. The premises used are a bit drab and though they are strictly regulated, the ambience is a bit like the blood – doning centre, being a strange mixture of homeliness and apprehension.

After ‘One Flew over the Cuckoo’s Nest’ was made and shown to generations of students, the Royal College decided that ECT could never be made to look cool ever again.

Regulators like NICE narrowed down the number of indications and the treatment itself changed a lot subsequent to most of the controlled trials that were conducted.  A different anesthetic is used, the energy level has been reduced, the ECT box is not made of mahogany any more and some units don’t even provide free toast after treatment. Arguably, the toast issue has been the most damaging.Whereas 6 to 8 treatments used to be standard in the toast era, now it’s often 12.

I doubt if ECT will be hived off to the private sector, but it wouldn’t totally surprise me to see new departments of electro-therapy in different settings, like sports medicine clinics or the corner of Debenhams.

Unlike ECT, tDCS has acquired a better vibe, being used by the Air Force to keep people concentrating and allegedly by students to improve their performance in games and exams. Perhaps more psychiatrists should be looking at it, but they won’t hurry because they are still struggling with their electrical baggage.

Steampunks would be delighted with a treatment like tDCS that was invented in 1798, but psychiatrists haven’t yet learned to love and embrace the anachronisms of modern life. 

 

 

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86. Setting food on fire: not really politics and not really science.

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Warning: hair fires are getting more common.

Behavioural activation is one thing, but most therapists wouldn’t recommend attacking a breakfast cereal cafe in Shoreditch with fire torches, even if such action seemed to strike at the heart of the neoliberal orthodoxy. As a child, I remember putting various kinds of food on to an open fire to see how well they burned. Result: cereals burn extremely well. Discussion: a packet of Ricicles with the top torn off is virtually a Molotov Cocktail. Have people learned nothing from the great fire of London?

There must be better ways of challenging gentrification. Karl Marx spent years in the great reading room at the British museum, working out how to win the class struggle. Possibly he over-thought the whole thing, but direct action against muesli wasn’t on his agenda.

As the person next to you in the waiting room might say, let me tell you about my latest hallucination. I was half asleep at the time, so the experience would be of no interest whatsoever to a psychiatrist. ‘Hypnagogic’ or ‘hypnopompic’, both suitable names for an electropop band or a small disco in Albufeira, are words to denote an experience that occurs when you are just dropping off or waking again. Such things are firmly in the ‘that’s- yawn-normal’ category and would only rate a single line on page 119 of a psychopathology textbook, even if anyone was still writing those.

Anyway, here’s what it was like. It was a circular image, on the lower half of my left visual field. It was brightly coloured but hard to make out. There seemed to be a mountain and on top of the mountain something like a person. There was no sound, but somehow the words ‘good works’ became associated with it, though the words were not spoken.

That’s it. But what to make of it? A trip to the slightly-over-intimate optician at Specsavers, or start a new religion?  One explanation of why we dream is to allow the rehearsal of potential responses to feared scenarios. Primitive peoples would have dreamt of being attacked by wild animals but now we dream about how we would turn the water off if the pipes burst – you may have different nightmares, but you should still install service valves for each appliance.

In the dream scenario, we appear to be paralysed and unable to take necessary action. This is supposed to be because these dreams occur in REM sleep, when the body’s motor system has been taken off-line for maintenance. But this is not helping me interpret my vision. It’s unlikely that a man on a technicolor mountain will give me instructions, if only because there are no mountains where I live, unless you count the coal tips at the power station.

Good works could mean a number of things, but I’m sensing the gist of it as behaving more constructively or generously or just more usefully. At the very least ‘good works’ means I’m not going to pursue my latest business idea, which is a range of homeopathic soups, provisionally titled ‘Memories of Heinz’. And it probably means stopping putting opportunistically low best offer bids on ebay items, just in case the seller is desperate to raise money.

Decades ago, I remember Father Higgins causing a stir when he seemed to go against the idea of Prayer. I think what he said was that you are judged on what you do, not what you think or say. Looking at that now, it doesn’t seem too controversial, following all the scandals that hit the churches. People were clearly behaving badly yet talking sweetly to the boss.

At a meeting this week I found myself in the coffee queue, behind an eminent colleague. I noticed him place his cup just slightly off beam below the dispensing nozzle, so that he got the full quota of frothy milk, but none of the squirt of coffee, which comes out about an inch to the left of centre. I watched the coffee spurt to the side of the cup and I watched him not notice. I watched him take a slurp of his coffee and complain it didn’t taste of anything. Why didn’t I say something? Answer: too much thinking and not enough behaviour, just like Karl Marx.

Getting the balance right between thinking, emotions and behaviour is what therapists do – on diagrams. The point of my dream, I think, is that behaviour comes first and we should help colleagues operate coffee machines even if they work for NICE.

Lots of strands of information feed into our dreams. If ‘good works’ means something to do with behaving better, then it does chime with some of the stuff I wrote about last year. I suggested that behaviourism had been abandoned prematurely in favour of cognitive approaches. I suggested that Art and Music and other skills therapies had been neglected in favour of talking. And I praised hunter / gatherer activities, or pottering, which is the natural human condition. I attempted to steal Nike’s slogan ‘just do it’ to symbolise putting the B back into CBT.

People are abandoning old assumptions about how to protect against sadness and anxiety. They are resorting to eclecticism and mixtures of lifestyle improvements and increasingly, to apps connected with social contact and fitness. Not to mention the people who are connecting batteries to special hats to improve their exam performance, or using Nitrous Oxide to make TV more enjoyable.

This is heretical, but merely running for miles is not a good work. That is why athletic activities have to be artificially and laboriously associated with charitable causes before they acquire a moral value. This is even more heretical but I venture to suggest that neither knitting nor chatting nor a combination of the two are intrinsically valuable activities. It’s easy to say what isn’t a good work; much harder to say what is. Here are my first thoughts on the matter, in the form of a multiple choice question.

Which of the following is a Good Work?

Donating one of your spare copies of Songs about Jane by Maroon 5 (statistics show there are on average 2.6 copies per household) to Cancer Relief.

A mindfulness based breathing exercise, such as blowing up a balloon, pausing to enjoy the pleasing tension in the larynx and the slight dizzy sensation caused by lowered pH.

One short burst of primal screaming followed by a cigarette

Writing down a negative thought using lemon juice as invisible ink, revealing it with a hair dryer and then burning it

Playing the Killers’ song ‘Everything will be alright’.

A friend tells me the man on the mountain sounds like Moses, the person who probably invented bullet points and coined the word ‘covet’. Moses set fire to lamb at times but not I think as part of an informal science experiment.

85. Facing the inevitable barrage of organic fruit.

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Body language gets you 90% of the marks.

 

The summer of love officially begins with The Royal College of Psychiatrists annual congress, starting on June 29th at the ICC. If you’re going to Birmingham, be sure to wear some flowers in your hair.

We know we will be picketed and probably ridiculed by groups opposed to psychiatry. A warning has gone out to wear proper ID and beware bogus journalists.

But, just maybe, this time around, instead of fighting off the pickets with laser pointers, pretending they are light sabres, we should just let our critics put us in the stocks, if they still have them in Birmingham – I know they still have the bull ring – and wait to get pelted with fruit. Waitrose organic blueberries would be acceptable.

I’m talking about Truth and Reconciliation again. We have to accept that Psychiatry as we know it is a twentieth century phenomenon, running on empty these last few years. It’s time to face our critics and recognise what we did.

We are accused as follows:

  • Started using bullet points, against the advice of the English teachers
  • Colluded with the drug companies to hype SSRIs and Atypicals so that huge amounts of money were wasted paying for drugs that were no better than older drugs that were dirt cheap.
  • Conspired to medicalise swathes of  human behaviour like normal sadness and over-activity in children, yet failed to offer any useful treatments for these problems.
  • Colluded with management and politicians to shut down all our asylums and most of our inpatient units, knowing full well that they would not be adequately replaced with community services.
  • In the name of public safety diverted most of what resources remained to locking people up in secure units and hanging on to them as long as possible.
  • Colluded with managers to implement electronic records, knowing that these would destroy anyone’s ability to write or find a narrative summary.
  • For the nicest of reasons, presided over a decline in the status of medical staff, ending up with no secretarial support, no office, nowhere to park, no say in how things are run, quitting or retiring early, no-one wanting to take our places and decaffeinated coffee.

If you’re going to Birmingham, be sure to wear some flowers in your hair. Like Belladonna. A crown of thorns is taking it too far.

As Scott McKenzie would put it: ‘There’s a whole generation, with a new explanation’.

I’m looking forward to hearing it, the explanation I mean. See you in the Bull Ring.

84. Learning lessons from cleverer sorts of creature.

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Dolphins. They don’t do SATS.

Matisse and Chase are action dogs who won Britain’s got Talent. The fact that dogs can be taught to walk across a tightrope should make the education establishment pause briefly over its tall latte. As legions of children are subjected to ever-changing methods of learning and testing, has it never occurred to teachers that all they need is a packet of food pellets and a buzzer? If not, they should try writing the learning objectives and lesson plans for a dolphin show.

The problem seems to be in the notion that learners need to ‘understand’ things.

Once you start down the road of Understanding, sooner or later, you will lose your way. As Spinal Tap observed, it’s a very thin line between clever and stupid.

The road to understanding ends with a Philosophy experiment, like how Schrodinger’s Cat can be alive and dead at the same time. The pursuit of Understanding has killed off skills learning and almost no-one can walk across a tightrope nowadays, not even Matisse if safety rules are respected. Apparently Matisse hasn’t got a great head for heights.

As I understand it – which I don’t need to – operant conditioning happens as follows: People (or dogs) blunder around randomly, certain behaviours get associated with nice or nasty experiences. This, in turn, makes it more or less likely the behaviour will be repeated. Rewarding behaviours with biscuits or fish allows trainers to create showbiz animals. It’s embarrassing to accept that operant conditioning remains the strongest determinant of our behaviour. But there are examples all around us if we look.

In front of me for instance is a jar of eucalyptus honey, which I am putting on my elbows. Although I have sat through countless hours of training in evidence – based medicine and statistics, my experiences with honey are completely homespun, not to say stupid. Like most experiments, it started randomly at a hotel somewhere. A particular constellation of circumstances occurred: sore elbows / time to waste / poor impulse control / spare sachet of honey / no-one looking / short sleeves / suspension of disbelief / random fluctuation of self limiting condition / not liking honey as a food.

Add to that perhaps the knowledge that many great discoveries really did happen by chance.

I am not saying – GMC fitness to practice committee, please note – that you should put honey on your sore places. I don’t think I should be doing it myself to be honest, since it is wrecking my reputation and my wool jumpers. And honey just does not fit into a touch-screen world.

I’m aware I am falling victim to Attribution Error. Being aware of it doesn’t stop it happening though. Placebo can still work, even if the subject is told it is a placebo. Even if there are neon lights flashing the word ‘Placebo’ in front of you and a fifty-strong male voice choir singing the word ‘Placebo’ right behind you. That’s why Understanding just isn’t necessary and might even be dangerous.

Which is also why it may not be quite as necessary to try and explain things as the current versions of User Involvement dictate. Some psychiatrists have got into trouble saying stupid things to patients in an attempts to explain how drugs work. The worst thing you can say, apparently, is ‘chemical imbalance’. It’s OK to say ‘chemical’ I think – though some people struggle with the notion that the brain is made of atoms –  it’s the ‘imbalance’ part that does the damage.

Once you start using words like ‘imbalance’ you can be sure you’re on slippery foundations. Next thing you’ll find you’ve said ‘Time’ or ‘Nature’ or ‘Rest’. Then its only a short step to mumbling something like ‘striving officiously against the inevitable darkness’ and ‘tickets to Switzerland’. If you say the words ‘balance’ or ‘imbalance’ you will hear the examiners screaming with laughter behind their one way mirror.

Psychiatrists might use the word ‘deficiency’ in the context of brain chemistry, but not ‘imbalance’. Not that deficiency (e.g. of serotonin) is a proven cause of depression. But the monoamine theory of depression did guide people’s understanding of the illness for many years. ‘Increasing’ serotonin was the simplistic explanation for how antidepressants might work, particularly those named serotonin re-uptake inhibitors.

There are reams of internet pages given over to an argument between anti-psychiatrists and the psychiatric establishment about whether any psychiatrist has actually used the phrase ‘chemical imbalance’. And indeed as to whether the monoamine theory included notions of balance.

Further reams explore whether it was a term that used to be used but has now been abandoned and the usage covered up, like documents in 1984.

Anti-psychiatrists  argue that psychiatrists concocted the notion of Imbalance with big pharma, in return for free logo pens. One of them scoured the literature to find use of the ‘I-word’ and came up with this example from a 2003 textbook:

Sometimes the explanation is as simplistic as ‘a chemical imbalance,’ while other patients and families may request brain imaging so that they can see the possible psychopathology or genetic analyses to calculate genetic risk’

As far as this paragraph goes, the stupidity of the chemical imbalance part is overshadowed by the rest of it, such as the idea of seeing psychopathology on an image of the brain. Even so, the usage seems to be an example of low-end explanatory waffle, rather than as a deliberate falsehood the board of Eli Lilley dreamed up as they circled their cauldron.

When talking about drugs, or honey, smart people know how to say ‘I don’t know’ But it’s not OK, as Ed Milliband found out at the election, to say ‘who cares?’

Just to reassure you, I am not keeping the medicinal honey anywhere near the food honey, and I have labelled it ‘Medicinal Use Only’ and ‘Not for Internal Use’, just like the Boots chemist would have done in 1965. It works by Osmosis I think, which is quite different from correcting an imbalance.

83. Bandwagon for sale, very low mileage.

A concrete windswept piazza, early in the morning, before the philosophers arrive.

I tried to warn the Liberal Democrats about the negative halo effect that occurs when anyone talks about mental illness in the media. As soon as the talk gets round to mental health, people become upset and change channel, without even knowing why. Not only that but they get grumpy and choke on their pop tarts. The reaction is deeply intuitive, like a brain stem reflex.

The Libs banged on about mental illness affecting one in four of us and needing to be put on the same footing as physical illness services, eliminating suicide etc, just as though they hadn’t read this blog. They didn’t listen and now they are a burned out ruin on the hard shoulder of politics.

Though the halo effect has been known for more than 50 years, this has not stopped a succession of doomed public awareness campaigns such as ‘defeat depression’.

We know that mental health information is perceived as toxic, but no-one has adequately explained why.

Since Shirley Star’s studies of public opinion in fifties USA, the consistent findings have been that people with mental illnesses are regarded as dangerous and unpredictable. Presumably, so too are violent criminals, but they get massive media coverage and scrutiny. Most likely, the ingredient that puts people off dealing with mental health is having to try and understand it. Once you start to think about it, even if you’re in the business, there’s a large parcel of mental work to be done before you can process the information.

For instance, drawing the line between unhappiness and depression, separating personality disorders from illnesses from disabilities, let alone facing the mind brain problem. We’re pretty quickly into Melvyn Bragg territory, but without his panel of expert communicators.

It’s exactly the same for other specialists. A motor mechanic recently tried to explain to me – in some detail – about what had gone wrong with the car’s air conditioning. I remember the phrase ‘wobble plate’, but to be honest that’s the only thing I can tell you about it now. I’ve had to abandon any smug pretensions to knowing my way round a Compressor. Though I will, soon, find an opportunity to say the words ‘wobble plate’, somehow or another.

I’d compare the negative halo to the effect of encountering a protest demonstration in a shopping centre.  First instincts are to avoid it, not particularly in case of violence, but more in case you are called upon to examine a complex issue, like whether a remote area of a foreign country has been shabbily treated. Thinking is the last thing you want to do in the Arndale Centre. But it’s the kind of thing you might do by listening to Radio 4 at about 8pm, alone in your car on a smooth stretch of highway. But then that’s your choice, if you’re in the mood for mental activity.

Outside the police station, a large sign reads PRIDE. I’m going slowly enough to recognise that PRIDE is an acronym – after each capital letter is a smaller word. Subliminally, I perceive the words to be: Pride, Respect, Integrity, Dedication and Empathy. Are these virtues (or sin, in the case of pride) really top of our list of desirable qualities in a police service? Surely, these are not the words you want to hear when the machetes are waving and the AKs start popping.

Having said that, I’ve had no success in weaving an acronym from the words, Taser, Cuffs, Tear-Gas, Smith, Wesson, Court and Prison.

Doubtless the police have their reasons for presenting themselves as social workers, such as the diminished number of real social workers. And obviously they have to try and maintain the moral high ground. Nevertheless, my brain stem reaction to the PRIDE sign was: misguided PR campaign. People are proud of the police because they stand up to horrible people, not because they are empathic. Bad Boys 3 will not be subtitled Good Boys.

The negative halo effect cannot be countered by dressing things up. On the contrary, we are set on guard most acutely by any hint of deception. Very large and fast neural systems are devoted to spotting trickery. It takes a lot of considered reflection to counteract such defences, which means weighing things up carefully. The very thing that stresses out the wobble plate.

82. Euripides Trousers …

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Bees. They just get on with it.

Up until recently being a teenager was not regarded as a mental disorder. After David Cameron urged us to hug a hoodie, teenage angst was virtually eradicated from the  diagnostic landscape.  But now, some people seem to want to regard teenagers not just as sad victims of poor trouser design, but as Patients.

Someone’s looked at the lyrics of The Kids are Alright by The Who and recognised that they really meant the opposite. The Times is running a campaign about children’s mental health. A lot of assertions are being made that children are unhappy, that they are living through unusually stressful times, that they are victims of the modern world.

Horrible articles are being written about teenagers, suggesting they are unfathomable monsters and the National Theatre is running Medea again. I’m sorry, but this children’s mental health campaign feels like a moral panic. Who is stoking it up, and why?

Somehow or another, ‘subjective well being’ has become confused with becoming mentally ill. I’m a hypochondriac, but does that really affect my chances of getting ill?

Here’s a test of your subjective well being, the one used by the Children’s Society, the people who gave us the christingle:

Here are five sentences about how you feel about your life as a whole. Please tick a box to say how much you agree with each of the sentences: My life is going well; My life is just right; I have a good life; I have what I want in life; The things in my life are excellent.

Subjective well-being is arguably a test of how smug and complacent people are. How would John Lennon have scored? How would we have wanted him to score?

Before we go any further, how desirable is it for everyone to think the things in their lives are excellent?

Children are apparently scoring worse in such studies since 2008. And UK children are being dragged down the international league table by girls’ concerns about their appearance. British girls are second last, only South Koreans scoring lower, despite their excellent android phones.

It’s election time, so Nick Clegg is using the present tense when he should be using the future subjunctive, which apparently exists in Spanish. He’s claiming that stuff is happening, like expanding children’s services, that just might happen one day but probably won’t. He is comparing children’s mental health services to cancer services. If doctors did that they’d be accused of an absurd fixation with the medical model.

Libby Purves, still top of my list for head of state once we become a republic, compared children’s mental un-health to cholera, though admits that there is ‘no single pump handle’ to sort out.

To Libby’s credit, she soon recognises the problem is not like cholera at all.  She blames children’s unhappiness on: divorce, drug use, exam anxiety, peer pressure, early sexualisation, information overload, loss of contact with nature, ubiquitous screens, TV, games consoles…

Just like our generation suffered so much from CDs and colour TV. Just like our parents generation was thrown into abject misery by antibiotics and Walt Disney.

And she goes on to suggest a list of practical solutions: a smartphone ban in schools, art classes, choirs, safe outdoor spaces, park keepers, bus conductors, beat coppers and finally, ‘volunteering and youth groups to be made fashionable and fun’.

No doubt Libby is on the right track in terms of placing the issue firmly in the Sociology Department. There’s a squeeze on social capital and no sign of quantitative easing. That’s not to say that useful modern inventions like apps and text messaging are deleterious to social capital – quite the reverse is true judging from the queues in Costa and Macdonalds.

Very soon, the children’s mental health campaign will have to contact Blur to see if they can borrow the slogan Modern Life is Rubbish. But remember, that album was released in 1993, which to the under 18’s is somewhere between Roman times and Wolf Hall. Modern life really was rubbish then, before graphical user interfaces and flat screens. And it was probably rubbish in 1893, the year when the US Supreme Court declared the tomato officially to be a vegetable.

And isn’t the rest of The Times newspaper filled with all the stuff that Libby regards as a cholera fountain? The cholera in question being market-driven, intra-sexual competition. There’s a lot of stuff about girls who hate themselves and almost nothing about bus conductors or park keepers. In the fashion section all the items are unfeasibly expensive apart from one token item from Primark. Any article about anything whatsoever, such as which is the best digital tyre pressure device, will be accompanied by a picture of a thin female person, probably one of the tiny girls employed to make the DFS sofas look massive. If Libby finds that pump handle she ought sort out some of her co-workers with it.

People have been casting aspersions on younger generations throughout history. This is perhaps the first time that teenagers are being castigated by being labelled mentally unhealthy. It’s a change from being considered morally deficient or stupid, but just as fatuous.

Mostly, there is no sense in medicalising the problems children face. There are no specific treatments or therapies that will help them and no army of skilled professionals waiting for Clegg to deploy them.

Luckily, there is little evidence that youngsters are any more mentally unhealthy than any other age group. Mental illness, like most other illnesses, gets more likely when people get older, like rust on cars. Children don’t get mentally ill in the same way as adults, not very often anyway. Although it is unbelievably awful when a suicide occurs in a young person, teenage girls’ rates of suicide are three time lower than middle aged women and twenty times lower than middle aged men.

People are not growing huge thumbs as a result of texting or walking into traffic because of ear phones. A teacher asked me recently whether schools should have mindfulness programs. But surely, a school is a mindfulness program?

Attempts are being made to impose guilt on schools and companies for being competitive, with the aim of selling them mental health services to patch up any bruised egos. The Times is doing something similar within its internally contradicted hand-wringing departments of greed and anti-greed. Thankfully our children our savvy enough not to join the stampede down to CAMHS.

Anyway, they can’t run in those trousers.

81. Treating old boilers with respect and dignity.

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Rechargeable goat, at docking station.

 

I once worked at a large asylum type hospital which had several hundred patients. One of them became utterly convinced he had been appointed as a psychiatric registrar and dressed and behaved exactly like a junior doctor, right down to the large radio-paging bleep we used to wear in our top pockets. At the time he was accepted as just another character in the very rich tapestry of eccentric people who inhabited that place, like the man who used to put his head round the door in meetings and say, ‘they’ll get them, won’t they?’

Later on I was sad to learn he had eventually been deemed as a hazard to other service users and transferred to a secure unit. The penalty for impersonating professionals is high in some cases, though anyone can call themselves a therapist, or a professor for that matter.

At present, I’m in a similar pretend role. It’s unofficial you understand, there is no paperwork from Jobcentre Plus, but at present I’m on attachment to a gas engineer. Together we are trying to solve a puzzle. If I was Philip K Dick, I would call this story Fault Code Number Five. We are talking about carbon monoxide to dioxide ratios and looking at little graphs and readings on the multi-meter. I am nodding wisely, pretending I understand.

I’m satisfied that I’m attached to the best guy in the field. He is young, he is Rumanian, he scored top of his year at training school and he reads Balzac and Tolstoy. He is a friend of a friend, so he is reluctant to take any money, but I will find a way of paying him in the end. He seems to accept presents of cheese or wine. He was happy to accept one of my favourite screwdrivers too, on the basis that I had another exactly similar one.

Fixing a boiler is more exactly like fixing a person than either of us realised. Engineers use a mixture of inductive and hypothetico-deductive reasoning, just like doctors. First you identify the problem and the history of the problem.

Then you collect a set of routine information. That allows a good guess at the diagnosis, or possible range of diagnoses.

I noticed how he used the back of his hand to test whether a pipe was warm all down its length, much as a surgeon would check for inflamed tissue. He tells me that these flexible pipes sometimes get blocked and I think, just like blood vessels.

After that it’s a matter of getting more specific information, running tests designed to confirm or eliminate each possibility. According to the manual, fault code number 5 means a problem with the gas valve or the flame recognition device. The engineer dismissed the gas valve option with a mere quizzical look, much as I would dismiss a long shot diagnosis like Porphyria or Syphilis. Flame recognition seemed more likely, so he replaced that part. This is where experience tells. I’d have had no idea that gas valves hardly ever went wrong, whereas burner devices degrade over time.

Everything seemed good for a few days, until we suddenly felt chilly, and there it was again, fault code number 5. Luckily, this fault responds to pressing the re-set button, which is where we see a significant departure from treatment in human beings. Very few of us have a physical button for re-set, though there are electrical devices that can automatically shock the heart as and when required.

Computers used to have a tiny hole allowing you to re-set the device with a paper clip. I’ve always assumed there was a little button just inside the hole, but thinking about it maybe it’s more like Acupuncture. Possibly you can stick pins in various parts of computers to make them work better. Maybe we could stick a knitting needle into the boiler – it is metal cased but it has a soft underbelly – and give it a little twiddle.  I hesitate to suggest this to the engineer. There are safety guidelines against doing this, something to do with getting electrocuted. Besides, there is almost no evidence base for Acupuncture in machinery, just like there isn’t with people either.

I can’t help remembering that my dad used to tap the end of the cathode ray tube with a wooden spatula to get the TV going. This generated a great sense of anticipation for a favourite program, since we had to get the TV warmed up a good 15 minutes in advance. My dad never did a controlled trial of spatula tapping versus just leaving the tube to warm up by itself. He’d have been astonished that this far into the computer era we still have to turn things off and on again to get them to work, yes you Mr Sky HD+ box, if you are listening, which you probably are.

The next stage was to ring the manufacturers in Holland and take further advice. They suggested checking the earth connections and the burner gasket. Also there is software available allowing us to do a diagnostic test via the boiler’s USB port. This bit seems so much better than medicine. The manufacturer of humans provided very limited after sales service, no USB port and no guarantee whatsoever. What’s more, our original instructions are a bit tatty after falling into the Dead Sea.

We got so excited about the diagnostic software but the bubble burst when the manufacturer hinted that it’s output would simply say; fault code number 5, fault code number 5, repeatedly, like Revolution Number 9 from the White Album. (Though 5, instead of 9. Obviously.)

It’s true that Ghost in the Machine was the worst album The Police made, but I’m wondering if intermittent faults might indicate a haunting of some kind. I consider sprinkling it with Holy Water, but again, its against regulations, something to do with electricity and water not liking each other. I can’t imagine the engineer taking it well if I bring in a priest. Let’s stick to the medical model.

Which brings me to the punchline. The so-called medical model is much derided in mental health circles, as though some other model could replace it. In engineering there is no controversy about how to conceptualise the process of fixing. There is no-one advocating Alternative Engineering, Values Based Engineering, Recovery Engineering or other abandonment of reason. When your boiler catches fire no-one sends for an astrologer.

Perhaps that is because people are not machines. Except that we are.

Come to think of it, I still have that wooden spatula…